What's the difference between a patient and a healthcare professional?
Is it education? Experience? Intelligence? Sometimes it's any combination of these factors, and sometimes it isn't. Sometimes the patient is a healthcare professional. Doctors get sick sometimes, too.
So when a pharmacist counsels a patient, it's important that you understand who you're talking to and how much they want or need to know. Of course, this is something that's taught in every pharmacy school in the country, and it seems pretty intuitive. You don't want to explain pharmacology to the 7-year old child, or tell a critical care nurse that "this white pill will make you feel better."
One place it does sometimes get a little complicated is the situation my preceptors are currently in. I'm in a drug information rotation, working for a company that produces, among other things, drug interaction databases for pharmacies and patient education handouts (obviously, for patients). The problem is that these two databases don't always coincide. The department creating the database for pharmacies/pharmacists tends to be a little more selective about which drug interactions and which side effects are included. They only include things that are likely to cause problems and that are decently well documented in the literature. The patient education handouts, on the other hand, include anything and everything. Everything listed in the package insert, every theoretical interaction and side effect, are all listed with warnings in strong language.
The retail pharmacies my company sells these products to are not happy about that. They're concerned that a patient will see these warnings and be angry that no one warned him or her about it. They're worried that the patient might just stop taking the medication on their own. It's a valid concern, I think; it happens more than it should.
The issue hasn't been resolved, and I'm not sure how it will be. But it brings up an important question. How much do you tell patients about their medications? There's a fine line between keeping patients informed and scaring them away. There are a lot of drugs that have extremely rare, but potentially serious, side effects. You can die from an allergic reaction to an antibiotic. Tylenol, even in low doses, can give you liver failure, and ibuprofen can in some cases give you renal failure. It's important that patients be aware that you have to be careful when taking drugs. But it's also important for them to understand why the drug is necessary.
Does that mean we shouldn't use these drugs? In general, no. For drugs that are currently on the market, we've decided that the benefits outweigh the potential risks by a great enough margin. But it's still scary to think that you might be the one patient in a million who gets a blood clot from birth control.
I think the best way to explain it is through risks and benefits. Yes, there is a risk for every drug you might take, and that's why it's better to be on fewer drugs. But in the vast majority of cases, you are more likely to get sick from the disease than from the drug.
(Of course, this comes with the caveat that the risks and benefits need to be clarified in clinical trials. But that's what phase III drug trials are for.)
It's not as obvious as it sounds, when you're the patient reading that package insert. I had a friend call me recently, one who's in the medical field, because she wasn't sure if she should take the course of antibiotic she had been prescribed. She was concerned about the serious (and potentially real) side effects she might get from the drug. I think it put things in perspective a little more when I pointed out that the risk of getting endocarditis (and having to be on IV antibiotics for six weeks at least) was greater than the risk of getting this side effect. But if you aren't used to thinking about things in terms of risk, benefit, and likelihood, it's easy to get caught up in what could happen.
That's an interesting dichotomy. It almost sounds like there's more info in the patient's pamphlets than in the pharmacy database. Why is it that way (that the pharmacy version is more selective) as opposed to the other way around?
Mostly because the pharmacy version has to be selective. When you're filling a prescription, if there's an interaction listed, it comes up as an error message regardless of whether it's significant to that patient or not. If too many of them pop up, you start to just bypass them without reading too closely and you might miss something important (they call that "alert fatigue"). If every potential interaction was in the database, you'd probably get about 5-10 messages for every prescription you filled. And in a store that fills 500 prescriptions in a day, that would significantly slow down the workflow as well. Patient information handouts don't have those kind of limitations, so the amount of information they should include is more debateable.